Galante Domenico, Viceré Andrea, Marrone Andrea, Verardi Filippo Maria, Viccaro Vincenzo, Giuliana Chiara, Pollio Benvenuto Ciro, Todisco Simona, Biscaglia Simone, Aurigemma Cristina, Romagnoli Enrico, Capalbo Gennaro, Trani Carlo, Burzotta Francesco, Crea Filippo, Campo Gianluca, Leone Antonio Maria
Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina, Gemelli Isola, Via di Ponte Quattro Capi, 39, 00186 Rome, Italy.
Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Int J Cardiol. 2025 Mar 1;422:132978. doi: 10.1016/j.ijcard.2025.132978. Epub 2025 Jan 10.
To investigate the influence of index of microcirculatory resistance (IMR) on fractional flow reserve (FFR) and adenosine-induced hyperemia (ΔPd/Pa-FFR) in patients with chronic (CCS) or stabilized acute coronary syndromes (ACS), utilizing various IMR threshold values.
Data were extracted from two ongoing Italian registries involving patients with CCS or stabilized ACS who underwent a #FullPhysiology approach [Pd/Pa, FFR, IMR, coronary flow reserve (CFR)] by bolus thermodilution technique in the left anterior descending artery. Correlations between IMR and both FFR and ΔPd/Pa-FFR were analyzed both globally and within three IMR-defined groups: Group 1 (IMR <25), Group 2 (25 ≤ IMR <40), and Group 3 (IMR ≥40). A multiple linear regression was employed to adjust for confounding factors.
Of 275 patients, 163 were in Group 1, 60 in Group 2, and 52 in Group 3. Globally, a weak but significant correlation was observed between IMR and both FFR (r = 0.170, p < 0.01) and ΔPd/Pa-FFR (r = -0.159, p < 0.01). After stratification only patients in Group 3 exhibited a significant and more pronounced, though still weak, correlation between FFR and IMR (r = 0.387, p < 0.01) coupled with a reduction of ΔPd/Pa-FFR as IMR values increased (r = -0.411, p < 0.01). After adjustment, a significant increase of 0.01 in FFR values was observed for every 14-unit rise in IMR (p < 0.01) in Group 3.
FFR appears particularly influenced by elevated IMR values (≥40) highlighting the importance of the #FullPhysiology approach in understanding epicardial and microvascular contribution of myocardial ischemia.
利用不同的微循环阻力指数（IMR）阈值，研究慢性冠状动脉综合征（CCS）或病情稳定的急性冠状动脉综合征（ACS）患者中，微循环阻力指数（IMR）对血流储备分数（FFR）和腺苷诱导的充血（ΔPd/Pa-FFR）的影响。
数据取自两个正在进行的意大利注册研究，这些研究涉及CCS或病情稳定的ACS患者，他们在左前降支通过团注热稀释技术接受了#全生理学方法[Pd/Pa、FFR、IMR、冠状动脉血流储备（CFR）]。在整体以及三个由IMR定义的组中分析IMR与FFR和ΔPd/Pa-FFR之间的相关性：第1组（IMR<25）、第2组（25≤IMR<40）和第3组（IMR≥40）。采用多元线性回归来调整混杂因素。
275例患者中，163例在第1组，60例在第2组，52例在第3组。整体上，观察到IMR与FFR（r = 0.170，p < 0.01）和ΔPd/Pa-FFR（r = -0.159，p < 0.01）之间存在微弱但显著的相关性。分层后，仅第3组患者的FFR与IMR之间表现出显著且更明显（尽管仍较弱）的相关性（r = 0.387，p < 0.01），并且随着IMR值增加，ΔPd/Pa-FFR降低（r = -0.411，p < 0.01）。调整后，第3组中IMR每升高14个单位，FFR值显著增加0.01（p < 0.01）。
FFR似乎特别受升高的IMR值（≥40）影响，这突出了#全生理学方法在理解心肌缺血的心外膜和微血管贡献方面的重要性。
